KULIAH UMUM BLOK SARAFRINI ANDRIANI

BAGIAN ILMU PENYAKIT SARAF

FK UNTAR

UMN DAN LMN

KELAINAN UPPER MOTOR NEURON :-Vaskular, tumor, infeksi, trauma, degeneratif, metabolik-Kejang-Sakit kepala (cefalgia)

KELAINAN LOWER MOTOR NEURON:Vaskular, tumor, infeksi/inflamasi, degeneratif, trauma, metabolik, obat2an

GEJALA KLINIS

Kelumpuhan spastik Normotrofi atau atrofi

krn disuse Hipertonus Reflek fisiologis

meningkat Reflek patologis + Fasikulasi dan fibrilasi

+

Kelumpuhan flacid Normotrofi atau atrofi

Hipotonus Reflek fisiologis

menurun Reflek patologis - Fasikulasi dan fibrilasi

-

UPPER MOTOR NEURON LOWER MOTOR NEURON

CEREBROVASCULAR DISEASE

Any abnormality of the brain resulting from a pathologic process of blood vessels—arteries, arterioles, capillaries, veins, or sinuses.

The pathologic change in the vessels takes the form of occlusion by thrombus or embolus, or of rupture.

The resulting abnormalities in the brain are of two types: ischemia, with and without infarction, and hemorrhage

CEREBROVASCULER DISEASE

Other forms of cerebrovascular disease are those due to altered permeability of the vascular wall, hypertension, and increased viscosity or other changes in the quality of blood.

ISCHEMIC STROKE

Transient Ischemic Attacks (TIAs) : transitory neurologic defects due to ischemia in a particular angioanatomic territory, lasting for minutes to hours and followed by complete restoration of function.

Embolic infarction Lacunar infarction

INTRACRANIAL HEMORRHAGE

Spontaneous Subarachnoid Hemorrhage due to Ruptured Saccular Aneurysm

Primary Intracerebral Hemorrhage Arteriovenous Malformation (AVM)

Craniocerebral Trauma

The basic problem is both simple & complex

simple because there is usually no question about the cause and complex because of the abstruse nature of a number of secondary and delayed effects.

PRIMARY INJURY

Skull Fractures Concussion and Contusion Diffuse Axonal Injury Acute Epidural Hemorrhage Acute and Chronic Subdural Hematomas Penetrating Injuries

SECONDARY INJURY

Hypoxia, hypotension Elevated intracranial pressure Hyperglicemia, Seizures Deep Venous Thrombosis and Pulmonary

Embolism Hyperthermia, infection

NEUROIMAGING

NEUROIMAGING

Intracranial Neoplasms

Benign or malignant (1) primary tumors (2) secondary tumors

Primary brain tumors

Pilocytic astrocytoma, grade I, Astrocytoma, grade II

Anaplastic astrocytoma, grade III, Glioblastoma multiforme, grade IV

Oligodendroglioma, Ependymoma Choroid plexus papilloma, Neuronal tumors

or mixed tumors (e.g., ganglioglioma) Embryonal tumors (medulloblastoma, PNET) Pineal parenchymal tumors

Other intracranial tumors

Metastatic tumors (breast and lung most common)

Meningeal tumors (meningioma), Vascular tumors (hemangioblastomas), Pituitary adenomas

Germ cell tumors (germinoma, teratoma) Primary CNS lymphoma, Nerve sheath tumors

(vestibular schwannoma) Developmental tumors (craniopharyngioma,

epidermoid, colloid cyst), Chondroid matrix tumors (chondrosarcoma, chordoma)

INFECTIONS

Infections involving the nervous system carry a high morbidity and mortality, particularly in developing countries where the burden of disease is great, diagnosis is difficult and limited

resources mean that availability and access to treatment is poor.

In the developed world, neurological infection is less frequent but continues to cause signifi cant problems of diagnosis and management.

INFECTIONS

Infections of the nervous system can be caused by viruses, bacteria, fungi or protozoa.

They may affect the lining of the brain, CSF, brain parenchyma, spinal cord, nerve roots, peripheral nerve or muscle.

INFECTIONS

meningitis : infl ammation involving the pia and arachnoid mater and the subarachnoid space.

Encephalitis is infection and inflammation within the brain parenchyma.

Focal infection causes abscess formation within or immediately adjacent to the brain or spinal cord.

INFECTIONS

These patterns may overlap and when infection involves the meninges, brain, spinal cord and nerve roots the descriptive compound terms are used: meningo-encephalitis, meningo-myelitis, encephalo-myelitis, meningo-radiculitis and meningo-encephalomyelitis.

EPILEPSY

epilepsy is as a disorder of brain characterized by an ongoing liability to recurrent epileptic seizures.

An epileptic seizure is transient clinical manifestations that result from an episode of epileptic neuronal activity.

The epileptic neuronal activity is a specific dysfunction, characterized by abnormal synchronization, excessive excitation and/or inadequate inhibition, and can affect small or large neuronal populations.

CLINICAL SIGNS

Sudden and usually brief, include motor, psychic, autonomic and sensory phenomenon, with or without alteration in consciousness or awareness

the symptoms depend on the part of the brain involved in the epileptic neuronal discharge, and the intensity of the discharge

Headache (CEPHALGIA)